Information Collection

Heart Transplant Recipient Follow Up Post 5 Year

IC 226418 under ICR 202508-0906-005 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10 Heart Transplant Recipient Follow Up Post 5 Year_Form_Clean.xlsx Heart Transplant Recipient Follow Up Post 5 Year	Form
10. Heart Transplant Recipient Follow Up Post 5 Year_Instructions.docx	Instruction
10. Heart Transplant Recipient Follow Up Post 5 Year_Form_redline.xlsx	Other-Redline
10 Heart Transplant Recipient Follow Up Post 5 Year_Form_Cl 10. Heart Transplant Recipient Follow Up Post 5 Year_Form_clean.xlsx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	Yes	Fillable Fileable
Form	10	Yes	Yes	Fillable Fileable
Other-Redline		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Privacy Act System of Records Notice #09-15-0055

FR Citation: 87 FR 46967

Number of Respondents: 149

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	27,376	2,566	24,810
Annual IC Time Burden (Hours)	13,688	1,283	12,405
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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